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Dissertations / Theses on the topic 'Health Programmes'
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Ellis, Susan Patricia. "Health promotion programmes : a national survey /." Ann Arbor, MI : UMI Dissertation Information Service, 1992. http://aleph.unisg.ch/hsgscan/hm00092825.pdf.
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Andersson, Camilla. "Challenges of studying complex community health promotion programmes : experiences from Stockholm diabetes prevention programme /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-703-0/.
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Suksiriserekul, Somchai. "The cost-utility analysis of some Thai public health programmes." Thesis, University of York, 1994. http://etheses.whiterose.ac.uk/9822/.
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Dixon, Simon. "Exploring preferences for compulsory health programmes using willingness to pay." Thesis, University of Sheffield, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.489655.
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Ma, R. "What strategies influence general practitioners to deliver public health programmes? : an example using the National Chlamydia Screening Programme." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2017. http://researchonline.lshtm.ac.uk/4645512/.
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General practitioners (GPs) have a role in improving population health through health promotion and disease prevention (HPDP) activities such as immunisations, screening, and lifestyle advice. However, GPs must also respond to the patient’s agenda in a consultation. With limited time in a consultation, it might be difficult for GPs to prioritise HPDP with their patients. My thesis aimed to offer insights into the behavioural determinants of GPs to deliver HPDP. I considered behaviour theories such as Ajzen’s Theory of Planned Behaviour (TPB) to help understand clinician behaviour and how they could be applied to influence their behaviour to deliver HPDP programmes. I conducted an overview of systematic reviews to examine impact of behavioural interventions, directed at GPs, to improve health of their patients. The overview suggested there is insufficient evidence for any type of intervention to be consistently effective in influencing GPs behaviour. The National Chlamydia Screening Programme aims to detect and treat chlamydia infection in young people. Primary Care Trusts used different behaviour interventions to encourage GPs to deliver screening. I interviewed GPs and practice nurses (PNs) in London about their experiences of delivering chlamydia screening and the behavioural interventions, such as those discussed in systematic reviews, to influence their behaviour to deliver other public health programmes. The interview data suggested the constructs of TPB - behavioural beliefs, normative beliefs, and control beliefs – could be used as a conceptual framework to explain why these primary care clinicians might deliver public health care. Strategies used to implement public health programmes need to consider how primary care clinicians might respond to the different constructs of TPB. In addition, organisational factors such as contracts and financial incentives, and perception of intrusion into the patient’s agenda need to be managed carefully as they could either facilitate or impede delivery of public health programmes.
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Spaar, Anne. "Prioritising prevention strategies for patients in antiretroviral treatment programmes in resource-limited settings /." Zürich, 2008. http://www.public-health-edu.ch/new/Abstracts/SA_25.03.09.pdf.
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Nilsen, Per. "Opening the Black Box of Community-Based Injury Prevention Programmes : Towards Improved Understanding of Factors that Influence Programme Effectiveness." Doctoral thesis, Linköping : Univ, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-7001.
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Didi, Fathimath Moosa. "Policy implementation in three primary health care programmes in the Maldives." Thesis, University of Manchester, 2006. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.668729.
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Linsley, Paul. "A realistic evaluation of two aggression management training programmes." Thesis, University of Nottingham, 2013. http://eprints.nottingham.ac.uk/27968/.
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Whilst the training of healthcare staff is seen as a key element to the prevention and management of violence and aggression, questions remain as to the effectiveness of these programmes in preparing staff to apply this to clinical practice. To date there is a relative paucity of well-designed studies into the effectiveness of the training to prevent and manage violence and aggression in healthcare settings. Within this context a study was conceived to examine the effectiveness of two aggression management training programmes in preparing staff for clinical practice. In order to provide a meaningful and evidence-based evaluation of the two programmes, Pawson and Tilley's Realistic Evaluation model was adopted for use in this study. In keeping with the chosen methodology, data was collected using a combination of methods including surveys, semi-structured interviews, and participant observation of training. A total of 64 participants were eligible for inclusion in the study; which ran over the course of a calendar year. The research highlighted that training should have relevance to the staff group undergoing instruction. That training should be conducted wherever possible in staff groups, tackling real problems, with participants reflecting and learning from their experience and from each other. It should also provide measures of competency that describe both workplace and organisational outcomes and describe the requirements of assessment. That training should be engaging and integrate decision-making, planning, organization and skill building and cover a range of interventions. Most importantly, was the need to help staff transfer what they had learnt as part of training to clinical practice. These factors are brought together in a model of training devised as part of this study called the PROMPTS Aggression Management Training Model ©. As the first study to apply realistic evaluation in aggression management research, it was a good fit, particularly given the growing emphasis on understanding how context influences evidence-based practice. The strengths and limitations of the approach are considered, including how to operationalize it. This approach provided a useful interpretive framework with which to make sense of the multiple factors that were simultaneously at play and being observed through various data sources, and for developing explanatory theory about aggression management training and its implementation in practice.
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Kochenderfer, Mary Anne. "Music after war : therapeutic music programmes in Bosnia and Herzegovina." Thesis, University of Edinburgh, 2006. http://hdl.handle.net/1842/1956.
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This thesis is a study of therapeutic music programmes in post-war Bosnia and Herzegovina. This study focuses on how different participant groups perceive programme aims and benefits and what these different perceptions reveal about the programmes as well as ways in which the local context impacts the programmes. Analysis is based on data gathered through interviews, observation, participant observation, and questionnaires obtained during five fieldwork visits undertaken between November 2003 and November 2004. While all participant groups agree that the programmes are beneficial, there are important differences in the ways different participant groups perceive programme benefits and the different ways in which the programmes approach sessions. Constructions of therapy appear to differ both between programmes and between international and local staff. All participant groups identified improved client communication and social skills as primary session outcomes. Clients appear to be largely unaware of the therapeutic aims of their sessions. Parents appear to have little influence and are not always notified that their children are involved with the programmes. International staff members appear to be intolerant of parents who do not heed their advice or reinforce progress made during sessions. In addition to running therapeutic sessions, these programmes work to increase inter-ethnic tolerance and to improve the skills of other local professionals. Programme success appears to be hindered by uncertainties inherent in working in a post-war environment. Developed and largely influenced by internationals, the programmes also face uncertainty as to whether they possess the necessary local leadership and ownership for long-term sustainability. There is evidence that tensions within, between, and outwith the programmes limit programme potential. Many of these tensions appear to be tied to local-international relations within programmes, which are exacerbated by national local-international tensions. A funding shortage has contributed to a competitive rather than a cooperative relationship between programmes. As the first detailed study of post-war therapeutic music programmes, this study has the potential to impact similar work in other regions and provides a more informed backdrop against which judgements can be made regarding the role and appropriateness of music as a form of therapy in post-war regions.
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Moreno, Serra Rodrigo Antonio. "Econometric evaluation of health care programmes and policiesin developing and transition countries." Thesis, University of York, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.507941.
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Lu, Qiuying Sandy, and 呂秋瑩. "Health economic evaluation of universal infant hepatitis B vaccination programmes in China." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/207183.
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Introduction: China has about 120 million hepatitis B virus (HBV) carriers and a 7.2% hepatitis B surface antigen (HBsAg) prevalence in 2006.This creates a huge disease burden and also leads to significant economic losses. Since 2002, a free universal infant hepatitis B vaccination programme has provideda 3-dose primary vaccination for all infants. Although some economic evaluations of this programme have been conducted, a comprehensive cost-effectiveness analysis (CEA) to estimate long-term benefit using mathematical modeling would aid understanding of population strategies for hepatitis B control in large populations. Moreover, the most common mode of infection is perinataltransmission at birth. However the more effective immunization programme involving screening women during pregnancy for HBV-carrier status and providing passive-active vaccination for newborns has not been implemented in China.
Aims: To identify the most cost-effective universal infant hepatitis B vaccination strategy for China.
Method: A hospital-based survey was conducted during 2010-2011 in a general hospital in Shenzhen, China, in order to obtain costing data to estimate the economic burden of chronic hepatitis B patients. Annual direct and indirect costs from this study were used as cost parameters in the CEA models. Mathematical models were developed to simulate perinatal transmission, vaccination programmes and disease progression using Markov modeling and decision trees. Quality-adjusted life year (QALYs) as well as health and monetary outcomes were also assessed. Univariate sensitivity analysis and probabilistic sensitivity analysis using Monte Carlo simulation were performed to test parameter uncertainty. Two programmes of screening of pregnant women for both HBsAg and/or HBeAg and the infant passive-active vaccination were compared with the current vaccine-only programme in one CEA, while the other CEA estimated the effect of the current infant programme compared with no vaccination.
Findings: The estimated total economic burden including annual direct and indirect cost among hepatitis B patients of RMB 43104.5 (US$6340.8). The economic burdens of associated disease states of hepatitis B infection were highest for hepatocellular carcinoma (HCC) (RMB 77297.1), decompensated cirrhosis (RMB 50725.7), chronic active hepatitis B (CAH) (RMB 37449.5) and finally compensated cirrhosis (RMB 37276.9). The average total economic burden per hepatitis B patient amounted to 46% of Shenzhen GDP per capitain 2010, and 5.4% of the city’s annual per capita income. The current vaccine-only infant vaccination programme was justified by costsavings, from both a societal and health care payer’s perspective, reducing new HBV infections by about 76%. This has produced a gain of 743,000 life-years and 620,000 QALYs given current numbers and savings of US$2~3billion saved over the lifetime of a national cohortof 10,000,000 newborns. A universal control programme involving the screening of pregnant women for HBsAg and passive-active vaccination, would reduce new infections by 13%, saving 436,000 life years and gaining 121,000 QALYs for a saving of about US$546 million compared with current vaccine-only programme.
Implications: The universal infant hepatitis B vaccination programme is currently a cost-effective strategy for hepatitis B control in China.A beneficial amendment to the current strategy wouldinclude screening of all pregnant women for HBsAg and vaccinating newborns in a passive-active way.published_or_final_version
Public Health
Doctoral
Doctor of Philosophy
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Diaz, Sonia Janeth. "Health managers' performance in Latin America and the impact of training programmes." Thesis, University of Liverpool, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.343752.
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Mashilo, Mmakubu. "Perceptions of Rand Water employees of access to worksite health promotion programmes." Diss., University of Pretoria, 2017. http://hdl.handle.net/2263/65581.
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Health care access is a significant and growing global health concern. Research indicates millions of individuals lacking access to healthcare services. Health care access is a basic human right, entrenched in the Bill of Rights in the Constitution of the Republic of South Africa, Act no 108 of 1996. Worksites are excellent platforms enhancing employee health and wellness services. It is essential that employees have access to worksite health initiatives, ensuring improved health, reducing absenteeism and increase productivity. It remains a concern whether worksites have adequate health care facilities, offering quality care and if they are accessible to all employees, as legislated in the Bill of Rights. The research undertakes to provide an answer to the question “what are the perceptions of Rand Water employees regarding access to worksite health care promotion programme services?” The goal of the study is to explore the employees’ perceptions of accessing worksite health care promotion programmes within Rand Water. The Health Belief Model (HBM) serves as a theoretical framework for the study. The study follows a qualitative research approach, describing Rand Water employees’ perceptions of access to worksite health care promotion programmes. The applied research method was selected, striving to assist decision-making at direct line levels, managerial levels and decision-maker levels to solve problems. A collective case study design is followed, collecting data directly from participants in their natural environment for studying interactions, attitudes and characteristics. The design assists in understanding and interpreting the meaning relating to their worksite. A non-probability sampling method was chosen, selecting 15 participants based at the Rietvlei site, who participated in a health care promotion programme. The study includes both genders and all levels of employees. The study is qualitative of nature. Data was collected through semi-structured interviews with an interview schedule. The one-on-one interview method applies, exploring perceptions of Rand Water employees regarding access to health care promotion programmes. The study findings indicate various barriers to health care promotion programmes, influencing and denying employees full access to the programme. Barriers range from privacy and confidentiality concerns, accessibility, support, insufficient resources, planning, policies and procedures, cultural barriers and communication. The research confirms influences of access to health care promotion programmes. The research findings suggest despite sufficient legislation, corroborating the reasons for restricted health care access in the worksite and with an intervention wellness model prepared, employees still experience access barriers to such services. The findings support the academic literature; access and utilisation of health services remain an important and critical global health care concern. The study results indicate access barriers influence utilisation of health services within Rand Water. The literature revealed organisations could benefit significantly through return on investment, providing integrated health and wellness services with full management support, policies and procedures aligned to their workforce. It is established that worksites cannot remain productive without maintaining health, job satisfaction and morale of their workforce. It is important for organisations to enable access to health care promotion programmes, striving to enhance performance and improved productivity, in identifying and alleviating personal and work-related challenges that may hinder unnecessary absenteeism.Mini Dissertation (MSW)--University of Pretoria, 2017.
Social Work and Criminology
MSW
Unrestricted
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Matthews, Zoe. "Child immunisation programmes in developing countries : assessing the demographic impact." Thesis, University of Southampton, 1993. https://eprints.soton.ac.uk/34278/.
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Yuan, Siyang. "Socially excluded mothers and infants : an evaluation of community based health promotion programmes." Thesis, Queen's University Belfast, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.486264.
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The aim of this thesis was to evaluate two community based health promotion programmes for Irishborn (NI) and Chinese immigrant mothers and infants living in deprived areas. Study 1: A cross-sectional study to compare differences in NI and Chinese immigrant mothers' dental health and mother and infant's weight status. Mothers' oral health and health related knowledge, attitudes and behaviours regarding oral health, infant feeding, childhood obesity and mother-infant bonding were compared. The findings suggested that Chinese compared with NI mothers had poorer oral health and health related knowledge, attitudes and behaviours, poor mother-infant bonding as well as poorer dental health. Study 2: An evaluation of'Treasure Baby Teeth' focussed on preschool child dental registration in deprived areas. It was delivered by health visitors during home visits. Dental registration rates were assessed 6 months before, 24 months during and 5 months after the intervention. The results indicated the improved dental registration rates for 0-2-year-old children living in the intervention wards 24 months during and 5 months after the intervention. Study 3: An evaluation 'of the CHllvIE (Chinese Immigrant Mothers health Education) Programme. This was developed and targeted at Chinese immigrant mothers of infants living in deprived areas using a controlled trial. Intervention group mothers were visited by SY at 8 weeks and 6 months on a one-to-one basis. Health topics included oral hygiene, dental attendance, infant feeding in relation to childhood caries and obesity, and mother-infant bonding. Two telephone calls were made at 4 months and 9 months to reinforce the information and provide supports to intervention group mothers. Improvements were demonstrated in the intervention group mothers' knowledge, attitudes and behaviours regarding oral health, infant feeding and childhood obesity a~d.'mother-infant bonding.
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Northrop, Mary. "Foundation degree programmes in health : perspectives of leaders and contributors across the UK." Thesis, Anglia Ruskin University, 2016. http://arro.anglia.ac.uk/700995/.
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Academics are at the forefront of the inception, design and delivery of Fds and therefore are responsible for ensuring the aims are met, but their views on the award and the delivery of curricula have not been sought. Foundation degrees (Fds) were introduced in 2000 and although courses have been evaluated, this has been from the employer or student perspective. Fds were created to meet a number of government agendas and were seen as unique, bringing together: life-long learning, widening participation, flexibility of delivery, employer engagement and work-experience. This research uses a mixed methods methodology. This includes: collating curriculum documents to explore commonalities and differences, a questionnaire sent out to academics across the UK, and semi-structured interviews of course teams from three Further Education colleges and three universities. Unexpected findings were that academics felt their own development had been enhanced through working with Fds. This had been transformative in relation to their career pathway or challenged them to develop their approaches to teaching. The other significant finding was that academics perceived Fd students as different or ‘other’ from those students on ‘traditional courses’. The students were described as hard working, motivated but also challenging and lacking self-confidence. A recurring theme was that Fds had provided a ‘second chance’. This led to discussions as to whether Fds are a bridge between a series of liminal states on a journey from affirmative to transformational learning. Other findings highlighted the complexity of developing and delivering Fds in collaboration with employers, other higher education providers and within institutions. The research found that Fds are complex and have no specific identity but consist of a family of awards. They meet widening participation and employers’ needs, but are not fully understood. The research has significance not only for Fds, but also future courses that aim to widen participation, include employer engagement and enable students to develop skills for specific work settings. The academics’ perspective adds to the existing views of employers and students of Fds about whether they have been successful.
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Morgan, Philip Arnold. "Pictures of change : distance learning as an innovation in health sciences." Thesis, University of Southampton, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.341607.
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Jonasson, Josefine. "Weight loss programmes over the Internet : opportunities and limitations /." Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-416-7/.
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Olalla, Juan Alberto NarvaÌez. "Implementation of the Global Malaria Control Strategy and Roll Back Malaria in Ecuador : a case study of the policy process." Thesis, University of Liverpool, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.250463.
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Czifra, Vanda. "Determinants of Childhood Mortality in Matlab, Bangladesh : How Health Intervention Programmes Can Bring Success." Thesis, Uppsala University, Department of Economics, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-8029.
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Given the question of how to further decrease childhood mortality and attain the fourth MDG in Bangladesh, the determinants of childhood mortality and successful health intervention programmes in a rural area of Bangladesh are examined in this paper. The binominal logit regression analysis, on Matlab HDSS data from 2001 to 2005, indicates that the child’s birth order, outcome of mother’s previous pregnancy, mother’s age, mother’s education, economic condition of the household, immunization, and place of delivery are important determining factors of childhood mortality. Interview discussions show that the delivery of health services is a determining factor for successful health intervention programmes. It is worth to note that childhood mortality levels are no longer significantly lower in the treatment area of Matlab. Furthermore, the intervention programmes in the area require continuous reform, especially in the fields of birth assistance and injury prevention.
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Chozos, Nick. "An investigation into error detection and recovery in UK National Health Service screening programmes." Thesis, University of Glasgow, 2009. http://theses.gla.ac.uk/1094/.
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The purpose of this thesis is to gain an understanding of the problems that may impede detection and recovery of NHS laboratory screening errors. This is done by developing an accident analysis technique that isolates and further analyzes error handling activities, and applying it in four case studies; four recent incidents where laboratory errors in NHS screening programmes resulted in multiple misdiagnoses over months or even years. These errors resulted in false yet plausible test results, thus being masked and almost impossible to detect in isolated cases. This technique is based on a theoretical framework that draws upon cognitive science and systems engineering, in order to explore the impact of plausibility on the entire process of error recovery. The four analyses are then integrated and compared, in order to produce a set of conclusions and recommendations. The main output of this work is the “Screening Error Recovery Model”; a model which captures and illustrates the different kinds of activities that took place during the organizational incident response of these four incidents. The model can be used to analyze and design error recovery procedures in complex, inter-organizational settings, such as the NHS, and its Primary/Secondary care structure.
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Rasoal, Chato. "Ethnocultural empathy measurement, psychometric properties, and differences between students in health care education programmes /." Doctoral thesis, Linköping : Department of Behavioural Sciences and Learning, Linköping University, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-51944.
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Alghamdi, Saleh. "The adoption of antimicrobial stewardship programmes in Ministry of Health hospitals in Saudi Arabia." Thesis, University of Hertfordshire, 2018. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.768496.
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Aim: This thesis aims to explore and investigate the level and process of adoption of Antimicrobial Stewardship Programmes (ASPs) and factors influencing their implementation in Saudi Ministry of Health (MOH) hospitals. The findings of this study will provide hospitals and policy makers with evidence-based recommendations on how barriers to ASPs adoption can be overcome, which will ultimately improve antimicrobial use and reduce antimicrobial resistance (AMR). Method: A mixed method approach was carried out using both qualitative and quantitative research methods. Semi-structured interviews were conducted with healthcare professionals in three Saudi hospitals to explore the enablers and barriers to their adoption of ASPs. A survey was then developed based on these findings to investigate the level of hospitals’ adoption of ASPs and factors influencing their implementation at a national level. Further, a case study using in-depth interviews was utilised to understand the process of ASP adoption in a Saudi hospital, and how adoption challenges were addressed. Finally, a self-administered questionnaire was used to examine patients’ knowledge and perceptions of antimicrobial use and resistance, and to evaluate the institutional role of patient education on antimicrobial use in two Saudi hospitals. The overall methodology of the research is summarised in Figure I. Results: Despite the introduction of a national ASP strategy, adoption of ASPs in Saudi MOH hospitals remains low. Organisational barriers such as the lack of senior management support, lack of supportive IT infrastructure and the shortage of ASP team members hinder hospitals’ efforts to adopt ASPs. Further barriers relate to the lack of formal enforcement by MOH and the physicians fears of patients' complications and clinical liability. Patients admitted to Saudi hospitals lack knowledge and perceptions of AMR, and the adoption of ASPs may improve hospitals’ role in patients' education. Conclusions: Despite the established benefits of ASPs, their adoption in Saudi MOH hospitals remains low. Urgent action is needed to address the strategies priorities associated with AMR, including access to antimicrobials, antimicrobial stewardship and education and research. Policy makers are urged to consider making ASPs adoption in hospitals a regulatory requirement supported by national guidelines and surveillance programmes. It is essential to increase the provision of ID and infection control residency and training programmes to meet the extreme shortage of ID physicians, pharmacists, microbiologists and infection control practitioners. Higher education institutions and teaching hospitals are required to introduce antimicrobial prescribing and stewardship competencies into undergraduate Medical, Pharmacy, Dental, Nursing and Veterinary curriculum, as well as introduction of AMR topics in order to increase knowledge and awareness of ASPs and AMR. Collaboration between ASPs adopting and non-adopting hospitals is essential to share implementation experience, strategies and solutions to overcome barriers. Healthcare specialised associations are needed to be part of AMR conversation and guide healthcare professionals’ training and accreditation. Multiple stakeholders should be actively part of the conversations around tacking AMR. Primary care, secondary care, community pharmacies and policy makers should strive to create a shared culture of responsibility among all healthcare partners to improve antimicrobial therapy and reduce risks of AMR
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McCoy, David Christopher Ariam. "The organisational determinants and challenges of integrated, coordinated and decentralised primary health care programmes." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2004. http://researchonline.lshtm.ac.uk/4646518/.
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This thesis covers the organisational factors affecting the integration and implementation of primary health care programmes of a provincial public sector health department in South Africa. It responds to the problems of district-level management structures and front-line health care providers being inundated and undermined by the implementation of uncoordinated and fragmented PHC programme activities and strategies. The organisational factors assessed included structural factors such as the interaction between line authority and staff authority, the relationship between divisions located at the centre and periphery of the department and the complementarity between positions and their ranks; management style and leadership; the variables inherent within different PHC programme areas that should influence organisational design; and relevant contextual factors. The thesis is a single case study. Data is mostly qualitative in nature, based mainly on participant observation, interview and document review. The thesis discusses the methodological and epistemological challenges to conducting in-depth research into the functioning of health departments, and illustrates the potential of such research for the strengthening of public health systems in developing countries. One of the main conclusions of the research was that the structural design of a health department can be very significant to its functioning. Some of the structural design faults identified by this research were the inadequate definition of the roles, functions and inter-relationships of several positions with the department; and the lack of congruence between the distribution of rank and the structural configuration of the department. The thesis suggests certain generalisable lessons that could be applied to the design of a developing country public health sector organogram. The study also confirmed that the contribution of management leadership to effective organisational cohesion and inter-divisional coordination is very important in the context of PHC programme coordination. Of particular note was the importance of providing a clear and appropriate strategic framework for planning, which would include the use of planning as a strategy to enhance organisational cohesion and coordination. Finally, the thesis describes the fundamental importance of adequately skilled human personnel within health departments to the effective integration and implementation of PHC programmes.
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Shigayeva, Altynay. "TB and HIV/AIDS control programmes in central Asia : health systems' challenges to sustainability." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2011. http://researchonline.lshtm.ac.uk/901046/.
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Health systems in central Asia (the former Soviet Union) face challenges to control TB and HIV/AIDS epidemics. Integration of communicable disease control programmes with the broader health system has been recommended to ensure programmes' sustainability. An important constraint for studying sustainability and integration has been a lack of conceptual clarity. Drawing on a critical assessmenot f publishedl iterature, a novel conceptualf ramework for the analysis of sustainability and integration in health systems has been developed. A sustainablec ommunicabled iseasep rogrammei s defined as continuouslye ffective in reducinga disease problem, responsive and adaptive to changes in the nature of disease epidemics, population needs or the contextual environment. Sustainability of a programme is conceptualised as having five dimensions: leadership, capacity, interactions, flexibility (adaptability) and performance (effectiveness, efficiency, equity). Existing frameworks of integration and health systems have been extended; defining levels of formal interactions between the system components. The research applied a case study approach. The case study was conducted in Kyrgyzstan, and relied on documentary review, qualitative interviews with key informants, and framework analysis. This study revealed several inter-related factors that affect the potential for sustainability of TB and HIV/AIDS programmes in Kyrgyzstan. Among overarching challenges for sustainability of both programmes are overall weak capacity of the health system and the reliance on international assistance for implementing the efforts to control the epidemics. This thesis highlights the importance of health system's structural and functional arrangements in sustaining the programmes into the future. In Kyrgyzstan, the factors such as fragmentation of governance and financing impede the development of effective interactions at the level of service delivery. In turn, fragmentation of service delivery remains the key impediment for efficiency, effectiveness and equity of disease control interventions. The prospects for sustainability of both programmes are constrained by institutional interests of domestic and international actors, who rarely consider the central question for sustainability that is efficiency of resources allocation and use. Weak disease surveillance and M&E systems emerged as one of the key barrier for development of effective disease control policies in the country and efficient planning of resources. Because of weaknesses of surveillance, this study could not provide the answer whether disease control efforts have resulted in the reduction of mortality and morbidity associated with TB and/or HIV/AIDS.
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Brocklehurst, Neil John. "An evaluation study of clinical supervision programmes in six NHS trusts." Thesis, University of Birmingham, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.322382.
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Darlington, Emily. "Understanding implementation of health promotion programmes : Conceptualization of the process, analysis of the role of determining factors involved in programme impact in school settings." Thesis, Clermont-Ferrand 2, 2016. http://www.theses.fr/2016CLF20025.
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La mise en œuvre de programmes de santé publique complexes est particulièrement délicate en milieu scolaire. Des différences sont fréquemment observées entre ce qui était attendu du programme et ce qui en résulte en réalité. Ces différences sont dues à un certain nombre de facteurs contextuels, en lien avec les caractéristiques propres du milieu, de la communauté et des acteurs concernés. Développer des programmes de prévention efficaces, implique de prendre en compte l’impact de ces facteurs sur le processus d’implantation des projets. Par conséquent, il convient de s’intéresser à deux questions majeures : la première est celle de la transférabilité des programmes, dont les effets sont difficiles à prévoir dans une telle variabilité contextuelle. La seconde question concerne la généralisation à l’échelon régional ou national de la mise en œuvre de tels programmes de prévention en milieu scolaire qui, loin d’être une évidence, est également sujette à de nombreux déterminants variables en fonction des situations. Alors que l’implantation et la mise en œuvre des programmes est un champ largement investigué dans le soin comme dans le management, il s’agit d’un champ de recherche en expansion dans le domaine de la prévention, de l’éducation à la santé et de la promotion de la santé. Cette thèse propose de s’intéresser aux modalités d’implantation des programmes avec un objectif double : une visée épistémique par une réflexion théorique sur les concepts à mobiliser, puis une confrontation empirique de cette approche dans trois études ; une visée transformative s’appuyant sur des propositions d’opérationnalisation de notre approche. Chaque étude contribuera à explorer et expliciter un aspect de l’implantation : des processus générés, aux effets observés, en prenant en compte les facteurs déterminants en jeu. Les résultats de ce travail mettent l’accent sur le fait que les caractéristiques initiales des différents contextes ont un impact majeur sur le processus d’implantation, à différents niveaux de mise en œuvre. Les interactions entre les facteurs sont complexes, elles s’inscrivent dans des boucles d’action-rétroaction. L’introduction d’un programme dans un contexte peut agir comme un révélateur de certaines conditions favorables ou défavorables, un élément perturbateur imposant de nouvelles contraintes, ou, au contraire, un nouvel élan stimulant la motivation des équipes. Il apparaît que les programmes sont « instrumentalisés » par les acteurs pour servir leurs propres objectifs en fonction des conditions de départ. Il s’agit par conséquent de questionner le statut et le potentiel des programmes implantés au sein de contextes d’une extrême complexité. Nous ne prônons pas un changement de paradigme, mais plutôt un déplacement du curseur d’une focalisation sur l’amélioration de la fidélité avec laquelle les programmes sont mis en œuvre, vers un ancrage fort dans les différents contextes. Cette stratégie nous semble particulièrement adaptée à une démarche de réduction des inégalités sociales de santé. Dans cette perspective, nous proposons l’élaboration de « patterns » d’implantation sur la base d’une analyse détaillée des éléments déterminants préexistant dans les contextes considérés. Pour développer cette approche, il est nécessaire de poursuivre les recherches afin d’analyser les combinaisons de facteurs contextuels dans différents types d’écoles comme dans d’autres milieuxImplementing health-related interventions is challenging in school settings. Discrepancies, between expected and actual programme outcomes, are often reported. They are, at least partly, due to contextual factors in the setting, the community and the stakeholders involved. The impact of these factors sets two challenges for the development of successful health promotion programmes: first, transferability and generalization, as end effects are in reality difficult to predict; second, the scaling up of interventions cannot be taken for granted, as the determinants involved are numerous and variable, depending on situations. While implementation research is substantial in healthcare or management, it is an emerging and growing field in health promotion. This work proposes to produce knowledge on implementation in health promotion, with a twofold approach based on a theoretical reflection, and its confrontation with three empirical studies. Each study contributes to understand a different aspect of implementation, namely the processes involved, the outputs resulting from the process and the influential factors in play. Findings put forward that specific characteristics of the context, which exist prior to implementation, influence the implementation process greatly, on various levels and according to complex loops of interactions. The new programme introduced sometimes acts as a revealer, a constraint, or a motivator. It is used as a tool, a guideline or a vision, depending on initial conditions, expectations and potentiality of the context of implementation. This work also discusses the way in which school stakeholders tend to “instrumentalize” programmes and guidelines for their own purpose. Questioning the design, status and potentiality of programmes is essential. Rather than proposing a paradigm shift, our suggestion is to move towards implementation research and programme design that focus on interactions between contexts and programmes, to reduce health inequities. It is about moving the cursor from evidence-base and fidelity, to a focus on contextual influencing implementation. Implementation patterns, based on a detailed understanding of contextual factors, could serve as guiding directions to support the implementation process, in a transformational change perspective. More research is needed on combinations of contextual factors in different types of school, and other types of settings, to further develop the approach presented in this work
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Hockland, Sue. "A pragmatic approach to identifying Aphelenchoides species for plant health quarantine and pest management programmes." Thesis, University of Reading, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.250716.
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The genus Aphelenchoides consists of over 140 nominal species, some of which are pathogenic to plants. Nematologists in statutory and other diagnostic laboratories need to be able to distinguish pathogens with confidence if financial losses and unnecessary chemical control are to be avoided, but no complete key to this genus has been available to date. A revised list of species was produced, deleting descriptions considered too poor for subsequent recognition. Key diagnostic characters were identified and promising features for future diagnostic use were investigated. A polytomous key (polykey) was developed and tested on 14 populations. The findings contributed to a further reduction in the number of valid species from a diagnostician's point of view, and also led to revisions of the polykey itself as key characters were tested for their distinguishing power. The primary key characters were identified as the length of the post-vulval sac (pvs) as a percentage of the distance between the vulva and the anus, the shape of the tail terminus and tail, body length, and the ratios `a' (body length divided by greatest body width) and `c' (body length divided by tail length). Promising key characters for the future are c' (tail length divided by body width at the anus or cloaca), the distance from the vulva to the anus, vulval body width, pvs length as a measure of the vulval body width, head width and all measurements associated with the median bulb. The polykey provides the essential foundation for the development of new diagnostic tools, including new keys for diagnostic use; preliminary work with molecular techniques showed promise for inclusion in diagnostic protocols, but further study will be required to develop reliable methodology for each of the economically important species. Nominators of new species should use the recording form to provide details of morphological and morphometric characters and compare resulting polycodes with others in the polykey and associated databases before publication. Likewise, the key should continue to be tested for its validity.
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Wild, Andrea Jane. "Community participation in health improvement programmes : a case study of tensions between policy and practice." Thesis, University of Warwick, 2003. http://wrap.warwick.ac.uk/2669/.
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This thesis explores the tensions between policy and practice in community participation in Health Improvement Programmes (HImPs). The HImP is used as a vehicle through which partnership working and public participation is health planning in the ‘new NHS’ may be explained, The literature review discusses key theories and models of community participation, power and policy implementation which informed the development of my key research questions and strategy. A review of the global, national and local influences upon a community participation in health planning is supplemented with primary research in the form of a detailed case study of one locality’s response to the national requirement to involve the public in the development of their HImP. A multi-method case study was employed using the following methods of data collection: observation, interviews, questionnaires and documentary analysis. The research presented identifies a number of issues as significant in affecting a locality’s approach to public participation, including: power; the organisational cultures(s) within the HImP partnership; the attitudes and capacity of those charged with developing participatory activities; and the impact of national priorities on local flexibility to respond to community identified priorities. The application of Alford’s (1975) structural interests theory to the findings provides a useful framework for assessing power relations and understanding why the HImP fails to represent community interests in the way that had been hoped. A number of recommendations are made to facilitate participation in health planning in the future, including: the need to address the national culture of risk avoidance; the need for better training in public participation skills for personnel charged with developing participatory opportunities; and the need for a mandatory performance framework related to community participation as a mechanism to ensure that participation issues are given the same attention as other nationally monitored issues.
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Richards, L. "The role and contribution of lay community food advisor programmes to public health in Canada." Thesis, City, University of London, 2018. http://openaccess.city.ac.uk/20426/.
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INTRODUCTION: Having members within communities as ‘natural helpers’ may ensure good understanding of local health issues and better delivery of relevant messages. Lay Community Food Advisors (LCFA) may be an effective means to increase coverage of health promotion, empower individuals and communities, help to reduce social exclusion and address the gap in nutritional inequalities. LCFAs may increase awareness of healthy eating and help people translate advice into practice thereby positively influencing patterns of behaviour. However, there is limited evidence supporting these programmes, particularly from a Canadian perspective. Research objectives: To describe the context, drivers and (identify) strategic components of different programme models To determine the role of programmes in addressing healthy eating behaviour (across the socio-economic spectrum) To determine the wider role and impact of programmes in food and public health RESEARCH DESIGN AND METHODOLOGY: A qualitative, case study approach of three key LCFA programmes in Ontario with both exploratory and explanatory aspects. Data collection included key informant interviews using semi-structured questionnaires, overt participant observation and document review. Analysis: Thematic Analysis was utilised as an overarching approach to data analysis, NVivo qualitative tool was utilised for analysis of interviews. The Health Policy Triangle and Multiple Streams Framework were both used as frameworks for policy analysis. FINDINGS: Programme models have been shown to be able to deliver on policy priorities and enable increased capacity at multiple levels: individual, community, organisational and policy. Programmes show examples of being both universally accessible and targeted in their approach, addressing a combination of food literacy and community engagement strategies. Programmes raise tensions around lay helping and issues of access and utilisation of programmes. DISCUSSION: Programmes play a key role in meeting public health policy priorities. Programmes address food literacy set within a social and community context, but may be more challenged to address the underlying determinants of health and raise some tension around whether they can reduce or exacerbate inequalities. However, the absence of programmes can leave a greater gap. Though they remain for the most part downstream with some midstream activity, there are opportunities for more upstream effort. CONCLUSION: Though localised, programmes can address food and public health policy objectives beyond food skills alone. Programmes and their role need to be viewed more broadly, with connections to the wider food system and environment and how they can be both policy levers and policy influencers. As well, programmes should not be seen as the solution to a complex problem that needs more than behavioural intervention, they must complement other strategies to improve public health across the system.
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Kvist, Lindholm Sofia. "The Paradoxes of Socio-Emotional Programmes in School : Young people’s perspectives and public health discourses." Doctoral thesis, Linköpings universitet, Tema Barn, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-122457.
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Over the past decades socio-emotional programmes have been implemented in schools worldwide. Depression in Swedish Adolescents (DISA) and Social and Emotional Training (SET) are two socio-emotional programmes being practised in Swedish schools. The aim of the present dissertation is to explore students’ perspectives on DISA and SET, as well as the programmes’ intentions and strategies. The empirical material consists of interviews with students taking part in DISA and SET, participant observations conducted in an elementary school practising SET, participant observations of DISA and SET instructor courses, and a broad range of textual material concerning the programmes. Article I reports on an inherent contradiction in DISA, where techniques designed as treatment are practised as universal prevention for girls as a group. The girls’ accounts of DISA demonstrate why this contradiction is problematic – it was not up to the girls as course participants to define what problems they were having, but the problems were instead defined for them by the course. Taking part in DISA and SET involves exercises in which the students are expected to selfdisclose in front of their classmates. Article II reports on how this task of self-disclosure had a potential for strengthening students’ peer relations, while it at the same time entailed a risk of triggering already on-going destructive interactions, such as bullying and harassment. Article III demonstrates that the potential of self-disclosure is not equally distributed across the students, but depends on their social status within their peer group. Article III also shows that the norm conveyed by the SET programme – that showing anger is an inappropriate behaviour –functioned locally as a way to justify exclusion and negative positioning of peers who showed anger in response to ill treatment. Article IV provides an in-depth analysis of exchanges in a SET lesson concerning how students should deal with exposure to the negative actions of peers. It demonstrates how the types of questions a teacher is instructed to pose to maintain a neutral attitude in practice involve using more implicit forms of authority to construct ideals concerning desirable behaviours. These ideals were formed by discussing fictive examples, which meant stripping students’ actions of meaning and detaching them from the social and cultural context to which they belong. The present dissertation concludes by giving recommendations for policy practice.Sedan millenniumskiftet har socio-emotionella program kommit att bli allt vanligare i skolor runtom i världen. Depression in Swedish Adolescents (DISA) och Social och Emotionell Träning (SET) utgör två socio-emotionella program som används i svenska skolan. Syftet med denna avhandling är att studera elevers perspektiv på DISA och SET, samt att studera programmens målsättning och design. Analysmaterialet består av intervjuer, deltagande observationer, programmanualer och dokument som beskriver och förklarar programmens utgångspunkter. Avhandlingen innefattar fyra artiklar. Artikel I belyser en konflikt i DISA programmet. DISA programmet lär ut tekniker som har utformats för att behandla depression. Programmet riktas dock till flickor generellt med syftet att förebygga att de utvecklar depression. Flickornas beskrivningar av DISA visar varför denna konflikt i programmet är problematisk. De fick inte själva definiera vilka problem de upplevde, istället var de tvungna att jobba med de problem som programmets övningar tillskrev dem. Övningarna som ingår i DISA och SET innebär moment där eleverna förväntas öppna sig inför varandra. Artikel II och III belyser hur detta fenomen hade potential att stärka elevernas sociala relationer, samtidigt som det också riskerade att leda till mobbning. I SET programmet tränas elever på att kontrollera sin ilska. Artikel III belyser hur normen – att visa ilska är ett olämpligt beteende – användes av eleverna för att rättfärdiga uteslutning av elever som visade ilska. Artikel IV består av en djupanalys av lektionen ’Vad kan du göra’ som handlar om hur elever bör agera om de utsätts för negativa handlingar från kamrater. Artikeln tar utgångspunkt i det dilemma som lärare ställs inför i SET programmet: att å ena sidan träna barnen i att anta socialt accepterade beteenden, och å andra sidan följa programmets krav på neutralitet. Analysen visar att de frågor som SET lärare använder för att åstadkomma en neutral hållning i praktiken medför mer implicita former av styrning där programmets ideal om önskvärda beteenden reproduceras. Önskvärda beteenden konstrueras genom att diskutera fiktiva fall utan att relatera dem till den sociala och kulturella kontext där barnen agerar och hanterar aktuella problem. Avhandlingen avslutas med en diskussion om hur ’barns psykiska hälsa’ och ’barns behov’ förstås och bemöts genom dessa program och vilka slutsatser som kan dras för utformandet av framtida insatser i skolan.
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Chepkurui, Viola. "Characterisation of national immunisation programmes in countries experiencing public health emergencies within the WHO African region." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33613.
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Background: The World Health Organisation (WHO) Africa region experiences multiple public health emergencies (PHEs) annually. PHEs have been documented to affect the provision of health services including immunisation. To our knowledge, there is a scarcity of studies characterising PHEs and the performance of national immunisation programmes (NIPs) in countries within the WHO Africa region that have experienced PHEs. This study assessed PHEs (armed conflicts, disasters, and disease outbreaks) and the performance of NIPs in the context of PHEs using global and regional immunisation targets. Methods Countries in the WHO Africa region that were reported to benefit from the African Public Health Emergency Fund (APHEF) were used as case studies. Data on PHEs and immunisation indicators recorded between 2010 and 2019 in the study countries were extracted from different electronic PHE databases (the Emergency Events database, the Uppsala Conflict Data Program, the WHO Emergency Preparedness and Response, and the Program for Monitoring Emerging Diseases Mail) and the WHO/UNICEF immunisation database, respectively. The PHEs and immunisation indicators were stratified by country and summarised using descriptive statistics. The Mann-Whitney U test was carried out to determine the association between the frequency of PHEs and the performance of NIPs in the selected countries from 2010 to 2019. Statistical significance was defined at p-value < 0.05. Results Thirteen countries were included in this study. A total of 175 disease outbreaks, 288 armed conflicts, and 318 disasters were reported to have occurred within the 13 countries from 2010 to 2019. The Democratic Republic of Congo had the highest total PHE count (n=208), while Liberia had the lowest (n=20). Only three of the 13 countries had a median coverage value for the third dose of the combined Diphtheria, Tetanus, and Pertussis vaccine (DTP3) that had attained the target for ≥90% immunisation coverage. Higher counts of armed conflict and total PHEs were statistically significantly (p=0.03) associated with not attaining MNT elimination. Conclusion PHEs are prevalent in the WHO Africa region, irrespective of the level of a country's immunisation maturity. In absence of effective interventions, PHEs have the potential to derail the progress of NIPs in the WHO Africa region. As we enter the Immunisation Agenda 2030 era, this study advocates for the prioritisation of interventions to mitigate the impacts of PHEs on the NIPs.
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Naidoo, Pamela. "Exploring tuberculosis (TB) patient's adherence to treatment regimens and prevention programmes at a public healt site." Master's thesis, University of Cape Town, 2006. http://hdl.handle.net/11427/9431.
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Includes bibliographical references.The aim of this study was to explore the factors that contribute to TB patient's adherence to the Directly Observed Treatment Short-Course (DOTS) strategy and the factors that serve as barriers to adherence. The study was set in a historically disadvantaged township, KhayeIitsha, a sub-district of the City of Cape Town in the Western Cape Province. A qualitative, phenomenological research design, which is part of an ethnographic tradition, was used.
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Wheeler, Alexina. "Teaching mode and commitment to change in women's fitness programmes /." Title page, contents and summary only, 1992. http://web4.library.adelaide.edu.au/theses/09EDM/09edmw562.pdf.
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Zembe, Yanga. "Community participation in the recruitment of community health workers :a case study of the three community health worker programmes in South Africa." Thesis, University of the Western Cape, 2009. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_7266_1299058637.
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This research investigates the nature and extent of community participation and involvement in the recruitment and selection processes for Community Health Workers (CHWs), primarily through detailed case studies of three CHW programmes, one in the Western Cape, another in KwaZulu-Natal, and a third which operates in the Western Cape and KwaZulu-Natal. The first utilizes CHWs in health education and home-based care in Khayelitsha and Nyanga. The second specializes in the training, management and supervision of home-based care CHWs in the rural areas of KwaZulu-Natal. The third utilizes CHWs in addressing maternal and child health issues in targeted peri-urban and rural areas in the three provinces. The mini-thesis is organized into five chapters: the first chapter provides the introduction and background as well as the methodological design of the mini-thesis
the second chapter focuses on providing a detailed literature review of relevant materials that cover the subject matter
the third chapter provides the descriptive background of the history of CHWs, CHW policies and community participation in South Africa, as well as a description of the three case study organizations
the fourth chapter describes and discusses the findings and the last and fifth chapter provides a summary of the findings as well as recommendations and conclusions.
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Mumba, Zulu Joseph. "Integration of national community-based health worker programmes in health systems : Lessons learned from Zambia and other low and middle income countries." Doctoral thesis, Umeå universitet, Epidemiologi och global hälsa, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-101807.
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Background: To address the huge human resources for health (HRH) crisis that Zambia and other low and middle income countries (LMICs) are experiencing, most LMICs have engaged the services of small scale community-based health worker (CBHW) programmes. However, several challenges affect the CBHWs’ ability to deliver services. Integration of national CBHW programmes into health systems is an emerging innovative strategy for addressing the challenges. Integration is important because it facilitates recognition of CBHWs in the national primary health care system. However, the integration process has not been optimal, and a more comprehensive understanding of the factors that shape the integration process is lacking. This study aimed at addressing this gap by analysing the integration process of national CBHW programmes in health systems in LMICs, with a special emphasis on Zambia. Methodology: This was a qualitative study that used case study and systematic review study designs. The case study focused on Zambia and analysed the integration processes of Community Health Assistants (CHAs) into the health system at district level (Papers I-III). Data collected using key informant interviews, participant observation, in-depth interviews and focus group discussions were analysed using thematic analysis. The systematic review analysed, using thematic and pathways analysis, the integration process of national CBHWs into health systems in LMICs (Brazil, Ethiopia, India and Pakistan)-(Paper IV). The framework on the integration of health innovations into health systems guided the overall analysis. Results: Factors that facilitated the integration of CHAs into the health system in Zambia included the HRH crisis which triggered the willingness by the Ministry of Health to develop and support implementation of the integration strategy-the CHA strategy. In addition, the attributes of the CHA strategy, such as the perceived competence of CHAs compared to other CBHWs, enhanced the community’s confidence in the CHA services. Involvement of the community in selecting CHAs also increased the community’s sense of programme ownership. However, health system characteristics such as limited support by some support staff, supply shortages as well as limited integration of CHAs into the district governance system affected CHAs’ ability to deliver services. In other LMICs, as in Zambia, the HRH problems necessitated the development of integration strategies. In addition, the perceived relative advantage of national CBHWs with regard to delivering health services compared to the other CBHWs also facilitated the integration process. Furthermore, the involvement of community members and some politicians in programme processes enhanced the perceived legitimacy, credibility and relevance of programmes in other LMICs. Finally, the integration process within the existing health systems enhanced programme compatibility with health system elements such as financing. However, a rapid scale-up process, resistance from other health workers, ineffective incentive structures, and discrimination of CBHWs based on social, gender and economic status inhibited the integration process of national CBHWs into the health systems. Conclusion: Strengthening the integration process requires fully integrating the programme into the district health governance system; being aware of the factors that can influence the integration process such as incentives, supplies and communication systems; clear definition of tasks and work relationships; and adopting a stepwise approach to integration process.
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Ribeiro, Lenira Fereira. "Absenteísmo no setor bancário: análise de um programa de intervenção." Programa de pós-graduação em saúde coletiva, 2004. http://www.repositorio.ufba.br/ri/handle/ri/10406.
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O objetivo deste trabalho foi estudar o absenteísmo numa população de trabalhadores, submetidos as ações de um programa de consultoria e diagnóstico em saúde, implantado numa instituição financeira estatal, para reduzir o absenteísmo por doença, através da mensuração dos afastamentos do trabalho por doença e das principais causas de afastamento. A população de trabalhadores foi avaliada em dois momentos distintos, antes da implantação do programa e a partir de dois anos após seu início. Foram avaliados 438 trabalhadores num estudo seqüencial do tipo case crossover, onde cada trabalhador foi controle dele mesmo. Cada trabalhador, para participar da população do estudo, precisou ter sido submetido as ações do programa e ter pelo menos duas avaliações de saúde, através dos exames do PCMSO (Programa de Controle Médico e Saúde Ocupacional), antes e depois da implantação do programa. Verificou-se uma redução no número de afastamentos, após a implantação do programa, passando de 29,0% no momento anterior ao programa, para 25,0% na segunda avaliação (um declínio de 1,2 %). As doenças osteomusculares apareceram como maior responsável pelos afastamentos do trabalho no grupo estudado, seguido pelas doenças do aparelho respiratório, tanto no momento anterior quanto no posterior à intervenção. Esses achados foram discutidos à luz da importância da implantação desses programas pelas empresas, assim como da necessidade de serem avaliados sistematicamente, para medir o alcance dos objetivos propostos, buscando garantir melhores condições de trabalho e saúde para os funcionários. Também são discutidas as proporções de doenças osteomusculares nessa categoria, associados às características das atividades desempenhadas.
Salvador
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Ginner, Hau Hanna. "Swedish young offenders in community-based rehabilitative programmes : Patterns of antisocial behaviour, mental health, and recidivism." Doctoral thesis, Stockholms universitet, Psykologiska institutionen, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-42465.
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The overall aim of this thesis was to explore patterns of antisocial behaviour, mental health and recidivism among Swedish young offenders in community-based rehabilitative programmes (n=189). Study I explored the character and severity of self-reported behavioural problems prior to programme participation. Four distinct subgroups were identified: subgroup (SG) 1 (n=60), boys exhibiting adolescent delinquency; SG 2 (n=65), boys exhibiting pronounced adolescent delinquency; SG 3 (n=48), boys exhibiting pronounced adolescent delinquency as well as criminality including violence; SG 4 (n=16), boys exhibiting pronounced adolescent delinquency as well as criminality including violence and drug-related crimes. Study II investigated the mental health of the participants, by means of the Strengths and Difficulty Questionnaire (SDQ). When relating SDQ-scores to the previously identified subgroups, SG 1 with the least prominent history of antisocial behaviour was found to resemble a normative sample, while the subgroups with more extensive histories of antisocial behaviour had significantly elevated scores on the hyperactivity/inattention and conduct problem scales. Study III investigated recidivism in criminality in the 18-months following programme start, finding that 60% of the participants had been registered as suspected of new crimes. SG 3 and 4 with the most extensive histories of antisocial behaviour were responsible for a significantly larger part of recidivism than expected. By contrast, SG 1, reporting the least antisocial behaviour in their past, was responsible for a significantly smaller part of the recidivism. This was true for all crimes as well as crimes of violence specifically, confirming the subgroups identified based on the self-reports. The results are related to developmental theories of antisocial behaviour and to contemporary research on risk assessment. Implications for the practice of rehabilitation of convicted young offenders are discussed.At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 1: In press Paper 2: Submitted. Paper 3: Submitted.
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Forman, D. "Shared learning : monitoring the attitudinal changes of staff and students on undergraduate health care professional programmes." Thesis, Sheffield Hallam University, 2000. http://shura.shu.ac.uk/19656/.
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The aim of this investigation was to monitor attitudinal changes of staff and students participating in undergraduate professional programmes to the implementation of shared learning over a four-year period. The programmes being studied were the BSc. Occupational Therapy, BSc. Diagnostic Radiography and BSc. Therapeutic Radiography Honours degrees. Each validated programme contained some syllabus areas that were taught together i.e. were shared across the professions. Initially, after a review of the existing literature on this issue, a questionnaire was designed as a research tool to enable both qualitative and quantitative data to be collected and analysed. The quantitative sections of the questionnaire were checked for reliability throughout the four years and achieved positive Cronbach Alpha results ranging from .7083 to .8984 in the four main concepts under investigation, namely the Pitfalls, Benefits, Curriculum Aspects and Social Aspects of the shared programmes. Over the four year period a total of 418 student questionnaires were collected and analysed. In addition to the quantitative data collected, qualitative data were also collected from the questionnaire from extracts of the minutes of Course Committee and Examination Board meetings and from videos of tutorials and seminars. All of these were analysed. The results showed fluctuations in the attitudes of both staff and students to shared learning over the four year period, but all those who participated showed a net favourable change in attitude by the end of the research investigation.
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Subba, Prasansa. "A formative study on the adaptation of mental health promotion programmes for perinatal depression in West Chitwan." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27469.
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Introduction: Depression in mothers can have debilitating consequences on the women themselves, their infants and their family. Thus, it is imperative to detect and treat perinatal depression early. Due to lack of awareness and stigma, help seeking, detection and treatment for perinatal depression in Nepal remains low. To counter barriers on lack of awareness, stigma and non-detection of mental health problems including depression, alcohol use disorder, psychosis and epilepsy, the PRogramme for Improving Mental Health carE (PRIME) developed and implemented a community sensitization programme and a Community Informant Detection Tool (CIDT). Neither of these programmes has focused on perinatal depression. This study aims to adapt the depression CIDT and the community sensitization programme to include perinatal depression. Methods: The CIDT and community sensitization programme were adapted using the following four steps. Firstly, a qualitative study was conducted with perinatal women with depressive symptoms visiting Meghauli and Dibyanagar health facilities or "gau-ghar clinic" (n=26) and service providers (n=34) to develop a culturally relevant content. Secondly, a draft CIDT and community sensitization manual were prepared based on the qualitative findings. Thirdly, a one-day workshop and several consultation meetings were held with mental health professionals (n=16) to ensure that the content was understandable and applicable to the context. Lastly, based on the workshop findings and consultation meetings, the manual and tools were modified and adapted for perinatal depression. Results: Due to poor awareness and stigma, none of our respondents had ever sought help for depression from the antenatal or postnatal service providers. Using local expressions for common depressive symptoms such as loss of interest, rumination, pessimistic views, extreme worries, restlessness, two separate CIDTs were developed each for antenatal and postnatal depression. Lack of support from the husband and family followed by poverty were the major contributing factors for depression. In addition, cultural factors such as the low position of women in patriarchal society and preference for son exacerbated problems in some women. The community sensitization manual was adapted to include local myths and facts about perinatal depression; causes with examples related to local beliefs; symptoms explained in local idioms; and role of the family. The heads of the families and key community members were recommended as key targets for the community sensitization programmes. Conclusion: It is important for any intervention to be responsive to local understanding and needs. The adapted CIDT and community sensitization manual has integrated the local issues and expressions of symptoms of perinatal depression for women in the Chitwan district.
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Löfgren, Hans O. "Preventive psychosocial parental and school programmes in a general population." Doctoral thesis, Umeå universitet, Barn- och ungdomspsykiatri, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-140737.
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Introduction Numerous preventive programmes have emerged, and need to be investigated to determine their effects on the normal population. Earlier studies have shown a decrease in depressive symptoms, positive effects on children’s disruptive behaviour problems, and an improvement in parental competence. About a fifth of the parents in previous studies had problem-oriented (targeted) reasons for enrolment, whereas the rest of the parents had general (universal) reasons. The results of those studies suggest that the programmes are cost effective in terms of Quality-Adjusted Life Years. Aim Four sub-studies were performed, and their aims were to investigate the effect of parental training programmes (PTPs) in a naturalistic setting on parents’ mental health in the general population, to investigate how PTPs affect parents’ sense of parental competence, to investigate how PTPs affect parental stress and analyse the parents open questions about the PTPs, and to investigate the feasibility and to measure the effect on depression, anxiety, and social problems of two preventive school programmes for pupils in grade 7. Method In a longitudinal quantitative study in a real-world setting, 279 parents from the general population in northern Sweden participated in five PTPs. A comparison group of 702 parents without intervention was included. Simultaneously, a community sample of 59 pupils in grade 7 participated in two preventive school programmes. Both studies were conducted from 2010 to 2013. Parents were assigned to professionally supported interventions that included 5-10 two-hour sessions. Respondents filled in a web-based questionnaire with the General Health Questionnaire (GHQ), the Parents Sense of Competence (PSOC) for parents who had children aged 0-17 years, and the Swedish Parenthood Stress Questionnaire (SPSQ) for parents who had children aged 0-10 years. The intervention groups’ results were compared to comparison group of 702 parents from northern Sweden that had not participated in any parental training programme. In the school study, one of the preventive programmes was an ongoing programme called “Life-Skills”, and the other was an implemented Canadian programme called “Choosing Healthy Actions and Thoughts” (CHAT). The pupils completed a test battery including the Sense of Coherence (SOC), the Children’s Depression Inventory (CDI), and the Youth Self-Report (YSR) instruments. Follow up of the parental programme study was done six months after the post-intervention measure, and follow up of the school study was at one year. Results The improvements in GHQ were statistically significant for the mean of the 279 parents in the intervention group compared to the mean of a comparison group of the 702 parents who did not receive any intervention. This suggests that evidence-based PTPs enhance parental well-being even for parents without problems. The intervention group showed a statistically significant improvement in parental competence compared to the comparison group over time. The intervention itself had a significant effect on parental satisfaction, but the efficacy effect was not sustained when taking into account potential confounders. In the SPSQ, the intervention group was smaller due to the fact that the instrument was not validated for children over the age of 10 and one of the parental training groups was only for parents of teenagers. A reduction of stress in the sub-scale of health problems was detected, but no other subscale showed the intervention to have a significant effect when controlling for confounding variables. In the school study, both programmes had good feasibility according to the stake- holders and had several positive mental health outcomes over time. Compared to Life-Skills, CHAT had more significant positive effects on reducing anxious/depressive symptoms and girls experienced significant positive effects on reduced anxious/depressive behaviour, while boys reduced their aggressive behaviours. Conclusions Earlier studies indicate that PTPs enhance perceived parental competence among referred parents. The present study shows that PTPs applied in the general population might also enhance perceived parental benefits such as improved health and satisfaction, suggesting that PTPs can be an important preventive strategy to enhance parenthood. The results suggest that parents who feel a need to increase their parenting competence might participate in PTPs based on lower scores than the comparison control group both before and after the intervention. The school-based programme shows that schools may be a suitable arena for preventive programmes because there was a significant short-term improvement in depression symptoms. Further studies need to explore how parents’ participation in PTPs affects children’s mental health in the general population in quantitative longitudinal studies in real-word settings. There is also a need for bigger studies and RCTs on school preventions and on how children’s health develops naturally in the population.
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Aiyede, Amos Onakho. "An evaluation of the perceptions of high school teenagers regarding sexual health promotion programmes in Whittlesea, Eastern Cape, South Africa : a qualitative study." Thesis, Stellenbosch : University of Stellenbosch, 2015. http://hdl.handle.net/10019.1/97213.
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Introduction
Health problems emanating from sexual behaviour include HIV/AIDS, other sexually transmitted infections and unintended pregnancies. The prevalence of HIV/AIDS and sexually transmitted infections among adolescents are considered high in South Africa. Also, the burden of unplanned pregnancies has wider implications in society. These problems occur in spite of a number of different sexual health promotion programmes. The aim of the study was to view the perception of high school teenagers to sexual health promotions programmes as well as their response to these programmes. The objectives of the study were:
1. To explore the perceptions of local teenagers regarding the content and materials used in local health promotion programmes
2. To explore the perceptions of local teenagers regarding the communication strategies and style used in local health promotion programmes
3. To explore the perceptions of local teenagers regarding the impact of local health promotion programmes on their behaviour
Method
This was a qualitative study. The study population was high school teenagers from the Whittlesea townships in the Eastern Cape province of South Africa. Fourteen purposefully selected teenagers from the seven high schools were individually interviewed. Analysis was done using the framework method.
Results
The study showed that the content of sexual health promotion programmes to which high school teenagers in Whittlesea were exposed to composed of sexual health education and the building of life skills. Perception of the messages in these contents was influenced by lack of communication on sexual matters within individual families and religious beliefs of participants. The programmes were considered to be practical and helpful. Methods that involved teenagers’ participation or interaction were generally preferred and the communication style was perceived as facilitating behavioural/attitudinal change.
Conclusion
In order for adolescent sexual health promotion programmes to be effective, they should employ methods that involve participation and human interaction. The involvement of parents, role models, religious groups and community services in sexual health promotion could be helpful in promoting sexual health education and lifestyle change amongst teenagers.
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Sinanovic, Edina. "A cost analysis of community-based distribution programmes and clinic-based services for contraceptives in selected areas in Khayelitsha." Master's thesis, University of Cape Town, 1997. http://hdl.handle.net/11427/9548.
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Bibliography: leaves 37-38.Family planning services in South Africa are now provided by the provincial and local authorities through clinics, hospitals, day hospitals, and mobile clinics. Both service providers and recipients have identified a range of problems with the current family planning service delivery system. Community-based distribution of contraceptives (CBD) has become a generally accepted alternative to clinic-based programmes for the distribution of contraceptives in many developing countries. The piloting of community-based distribution of contraceptives project in Khayelitsha, Cape Town / South Africa, is being undertaken by The Planned Parenthood Association of South Africa (a non-governmental organization), in collaboration with two other NGOs who run preventive and promotive health projects, SACLA and Zibonele. The objective of this study was to perform a cost analysis of alternative methods for providing effective contraceptive services. Clinic-based services for contraceptives, day hospital-based contraceptive services, and community-based distribution (CBD) of contraceptives programmes were evaluated. The following items were costed: salaries, contraceptives, buildings, equipment, vehicle, transport, repairs & maintenance, utilities, initial training, short-in-service training, and consultancy.
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Yu, Ting-fung. "A study of safety and health education construction and construction management programmes at tetiary [i.e. tertiary] level." Click to view the E-thesis via HKU Scholars Hub, 2005. http://lookup.lib.hku.hk/lookup/bib/B3793692X.
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LaMontagne, D. Scott. "Rationale, public health approaches, and policy implications of implementing community-level screening programmes for Chlamydia trachomatis infection." Thesis, Middlesex University, 2005. http://eprints.mdx.ac.uk/6884/.
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This context statement outlines my published research in three themes adapted from the ten criteria for screenings established by Wilson and Jungner (1968) Chlamydia trachomatis as a public health problem implementation of large-scale chlamydia screening programmes; and monitoring and evaluation of chlamydia screening programmes. These themes are supported by seven published papers quantifýing the epidemiology of chlamydial infection in several populations; describing the development, implementation and first year results of a national chlamydiac screening programme; and demonstrating four methods of evaluation - assessment of screening criteria, use of positivity to measure disease changes in the population clinical audits of provider ddherence to screening guidelines and fiscal analysis of costs through economic modelling. My research utilised a diverse set of study designs and methodological approaches: a) confirmatory studies of previously published research; b) cross-sectional studies with differing levels of statistiscal sophistication c) clinical policy review using questionnaires to health care providers d) economic modelling of budget expenditures and decision-tree and sensitivity analyses and e) an evaluation of a chlamydia screening programme combining retrospective cross-sectional analysis and multivariate logistic regression with sensitivity and efficiency analyses. My research has revealed significant levels of chlamydia morbidity in a variety of populations and settings in the United States and United Kingdom and has demonstrated consistently increasing trends in rates of diagnosed chlamydial infections among genitourinary medicine(GUM) clinic attenders in the UK. These data suggest that chlamydial infection is a prevalent disease in both countries and contributes to a significant global public health problem. I have examined the genesis of a new national chlamydia screening programme in the UK, and have shown the continued feasibility and acceptability of chlamydia screening , affirmed that screening in high prevalence populations is a successful strategy for disease detection, and improved our understanding of the sexual behaviours that continue to drive this epidemic. My evaluation of the longest running chlamydia screening programme in the US has illustrated the value of periodic assessments in screening protocols and lead to the revision in selection criteria for women screened in the north western US. I have found utihty in a variety of methods to monitor and evaluate chlamydia screening programmes. The application of sensitivity and efficiency thresholds to sets of screening criteria proved useful in evaluating c riteriap erformancea ndi ncreasing criteria efficiency. Using chlamydia test positivity as a surrogate measure for prevalence could adequately measure programme impact for the National Chlamydia Screening Programme in England. Clinical audits of service providers regarding published guidelines for chlamydia screening in termination of pregnancy services demonstratpd practice variation for chlamydia screening in these settings and suggested harmonisation of guidelines to increase adherence. Finally, my research of screening programme costs using economic models proved a useful tool to explore the average costs of screening and variations in estimates as local programmes revise their implementation and operational structure for chlamydia screening, and recommend this method be used to inform resource allocation for future phases of the National Chlamydia Screening Programme in England.
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Romeo-Velilla, María. "Complementarity of individual-level and community-level health promotion programmes : a longitudinal and qualitative study of empowerment." Thesis, Staffordshire University, 2017. http://eprints.staffs.ac.uk/3885/.
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Health inequalities are the result of social inequalities and a major concern in the UK. In 1986 the Ottawa Charter for Health Promotion committed to tackling such health inequalities and defined health promotion as ‘the process of enabling people to increase control over, and to improve, their health’, with the concept of empowerment at the centre. Health promotion approaches can be broadly categorised into top-down and bottom-up programmes. Tensions between these exist and the value of a balanced approach has been recognised. However, it is not well understood if and how participants of programmes that take such different approaches experience empowerment and, if they could complement one another. This research was set in Stoke-on-Trent, a city with considerable health challenges and inequalities. Two ‘real world’ health promotion programmes were considered: (i) The Lifestyle Service (LS), a top-down individual-level programme; and (ii) My Community Matters (MCM), a bottom-up, community-level programme. Each was studied using longitudinal qualitative methods. Baseline interviews (n=23, LS; n=28, MCM) were analysed using thematic analysis. At one year, follow-up interviews were analysed using comparative analysis and following constructivist grounded theory (n=13, LS; n=17, MCM). For the LS, the thematic analysis revealed three master themes at baseline (past experiences, expectations, and barriers), and a model with three categories at follow-up (identification, planning, and action). The LS was primarily experienced with a providing role similar to person-centred approaches. For MCM, the thematic analysis revealed two master themes at baseline (community deterioration and perspectives towards community improvement), and at follow-up a model with four categories (power influences, community deciding, acting, and consequences). This programme was experienced with a providing role by ‘disengaged’ residents, but with a role of enabling action by ‘engaged’ residents. This provides novel insight into participant experiences of empowerment through individual- and community-level health programmes with recommendations of how such approaches can better collaborate and complement one another as part of an overall effort to improve health and reduce health inequalities.
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Frewen, Sharon H. "Health belief model interpretations of sociopsychological factors associated with compliance for weight loss and cardiac rehabilitation programmes." Master's thesis, University of Cape Town, 1991. http://hdl.handle.net/11427/17074.
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Bibliography: pages 201-218.Four aims were formulated for the present study. The first was to construct a questionnaire, using the Health Belief Model (HBM) as an organizing rubric, and to test its psychometric properties in a pilot study. The second was to utilize the questionnaire to understand why individuals did or did not comply on the University of Cape Town Weight Loss and Heart Foundation Cardiac Rehabilitation programmes during the period 1987 to 1989. A third aim was to establish possible commonalities and/or differences between and within groups of weight loss and cardiac compliers and non-compliers on these programmes. This would address the gap in most studies which have only looked at one particular health behaviour at a time. The fourth aim was to accumulate information about the current health activities (or long-term compliance) and beliefs of individuals and to compare how these had changed over a period of time.
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Bucheli, Tamara Mancero. "Information-use for decision-making in the vector-borne disease control programmes of Ecuador and Colombia." Thesis, University of Liverpool, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.250346.
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Rickard, Colin John. "A study of the community reprovision programmes of the psychiatric institutions in England 1993-1995." Thesis, University College London (University of London), 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.267763.
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